Most elders would like to stay in their homes for as long as possible, but when the time comes, looking into senior housing options for yourself or an elder in your family can be a daunting task. Where do you start? What level of care is needed? Will you or your loved one feel comfortable there?

By Heidi Tetzman

Today there are several options for seniors that fit different levels of care and income ranges. Luckily in the Fargo-Moorhead area, there are enough places to choose from that you are likely to find a good fit. It can start with a simple Google search or your phone book, and a list of questions you have when looking for a retirement community that might work for you, your spouse, or a family member.When help is needed
If an elder prefers to stay in his home, when does the time come to look into other options?
Carol Bradley Bursack, a local elder care expert and founder of Minding Our Elders, a popular blog about caring for seniors, says many older people are able to live on their own for some time with some in-home help and a personal alarm. However, as time passes, especially after the loss of a spouse, safety and quality of life issues begin to surface for some seniors. They may fall and not be able to activate their alarm, for example, or they may become more isolated with fewer opportunities to socialize. Cooking may become a challenge, and then eating habits deteriorate.
Bursack says a good assisted living center can put family members––as well as the elder––at ease. The anxieties of keeping house or not having medical help on hand are relieved. She says seniors then can truly have a chance to thrive.
“Perhaps most importantly, they make new friends and have an abundance of activities to choose from,” Bursack says.
Teri Walter, case management coordinator at Rosewood on Broadway in Fargo, says it is usually a family member that looks into housing options, but it can also be a case manager with the county. The search depends on the situation and on the elder, but often it is precipitated by a crisis––a fall or a stroke, for example. In these cases, there isn’t much planning beforehand.Approaching the topic
How do you approach the topic with a loved one before a crisis happens? Conversations leading up to a decision differ, with some elders being more convinced they should consider senior housing if they feel their family caretakers are getting burned out, while others will feel they deserve to be taken care of in their home no matter what, Walter says. If the elder is open to it, it can help to visit and become familiar with the senior living community, or start by participating in a day program.
“It can also be helpful if a doctor is on board, in broaching the subject with an elder about moving to a place where they can get the care they need,” Walter says. “Many elders put a lot of trust in what the doctor says.” Ministers or priests weighing in can also be influential.
Bursack warns not to approach the subject as if you’ve already made the decision. She suggests bringing up the topic gently and being sensitive to their feelings.
“Leaving a home where he or she lived with a life partner, raised kids and once had friends among the neighbors is emotionally difficult. Whittling down a lifetime of possessions is hard. Be kind, be sensitive and try to make it be about your parent and not about you,” Bursack says.
Mention the benefits: no more work around the house to worry about or meals to make, more social things to do, etc. You can try offering a tour of an assisted living center, but don’t force the issue. Drop the subject if necessary.
“It’s hard to wait, but you may need to,” Bursack says. Wait for the right moment, and try again.
As much as you may emphasize safety as a concern, she says that unfortunately, there may need to be another fall or something similar before the elder will be more willing to consider moving. An intervention of sorts is another option, bringing the family together to express their concerns to the elder.
“It’s just easier if you can swing it, to let the parent make the decision,” Bursack says.Eldercarelink.com offers a free conversation guide that could help break the ice.Independent living versus assisted living
Independent living can be a perfect fit for 55-plus active, healthy adults who do not yet require assistance with daily living. In-home care may be ordered, but it is not usually needed in an independent living setting.
In general, assisted living is a housing option for those who need help with some activities of daily living, including very basic help with medications. Bursack adds that assisted living centers don’t usually provide 24-hour medical care, but basic in-home services are available to provide help with medications and other health-related needs.
Most senior communities offer a combination of independent living, assisted living, and memory care. These combined services are sometimes called Continuing Care Retirement Communities, or CCRCs. Independent and assisted living communities in Fargo and Moorhead include River Pointe, Eventide Senior Living Communities, Bethany Retirement Living, Edgewood Vista, Evergreens, Golden Living Community, One Oak Place, Pioneer House, Riverview Place, and Waterford at Harwood Groves.Preference Depends on Need, Personality
What people look for in a retirement community varies. Location can be important, with some wanting to live closer to family, or wanting to join a friend where they live at an assisted living center. Others might prefer a more residential, home setting. Bursack says rural areas often offer this type of assisted living, where the homeowners care for four to six seniors. Access to farm animals and pets can be another perk. Bursack adds that small, family-style living centers can be found in the city as well.
Some prefer the amenities of a larger assisted living center. Senior living communities, like River Pointe, for example, usually offer a wide variety of activities and social events. River Pointe offers an action-packed calendar including fitness classes, arts and crafts, a singing group, movies, bridge, dominoes, coffee socials, lemonade socials “on the patio,” and many more. Residents can participate as little or as much as they want.
Bursack cautions to know what services are covered in the contract you sign. Assisted living centers have much more freedom to decide which services to provide since they are not regulated in the same way as nursing homes.
“Ask about added services such as personal care, transportation to doctor’s appointments, and special diets. You’ll want to be clear on what is in the contract and what is going to cost extra,” she says.
Chad Boeddeker, housing director of River Pointe in Moorhead, says having three levels of care (independent, assisted, and memory) all in one place has its advantages. “Our community offers the services that residents appreciate now, and the peace of mind knowing that assisted living and memory care are available if ever needed.”
Potential assisted living and memory care residents are assessed by the nursing director to help determine the level of care needed. River Pointe does not separate couples unless there is a safety concern and after they have consulted with a family member.
Cost may also be a factor in choosing senior housing. It can be expensive, with costs into the thousands per month, based on the type of housing and the level of care. Some choose to pay privately by liquidating farms or homes, for example, to pay for care. Others have long-term care insurance. Depending on the level of care, when someone needs care but doesn’t have the money, Medicaid pays (if they qualify), which is funded by federal and state dollars.
Places like Fargo’s privately owned University Drive Manor can be an affordable option. Office Manager Sharon Larson says they offer one-bedroom apartments, and the rent is based on 30 percent of a resident’s income, who must be 62 years old or older, or disabled, or handicapped. For example, if your Social Security is $650, rent is likely to not be over $200, and the government subsidizes the rest.
Larson says she wouldn’t call University Drive Manor “independent living” necessarily, because people from Social Services do come in to help the residents—to clean their apartments or to help with showering, for example, but she also wouldn’t call it assisted living, because there are no medical people on staff. This doesn’t mean nobody is around for the residents, however.
“Sometimes I tie shoes, sometimes I turn clocks back, sometimes I give hugs. I have lots of interaction with the residents,” Larson says.
In University Drive Manor’s apartments, couples can live together. Only one spouse of a couple has to qualify to live there. Residents do have to pare down what they bring, as space is limited.
There are lots of opportunities for social interaction: “It has its own built-in community, without having to brave the weather,” Larson says––coffee in the morning, a community room, big-screen TV, bingo, potlucks, and lunch served daily by Meals on Wheels, to name a few.
“It’s a nice life. Simple, fun. People say it’s clean here. Not a place to go to die, but a place to go to live,” Larson says.Nursing homes
The term “nursing home” is often misused, and can carry negative images for people, though Bursack believes much of this stigma has gone away.
“When people need skilled nursing services, they generally move to a nursing home. Today’s nursing homes, at least in this area, are really quite good,” she says.
A nursing home involves a 24-hour skilled nursing staff for those who require more care than an apartment living or assisted living situation. A nursing home may not only serve seniors, but also those with disabilities or who are ventilator-dependent. It is still not as much care as a hospital would provide.
“North Dakota has great nursing homes, yet they all have their differences. Not right or wrong, just different,” Walter says. “Different things are important to different families. Some like a more clinical environment, some want it more laid back. Others prefer a Christian atmosphere.”
Rosewood on Broadway is one nursing home in the area that also provides memory care. They provide long-term care as well as short-term rehab and an adult day program.
Most nursing homes in the area offer some form of memory care and rehabilitation. The best way to find out is to call or look on the Internet.
There are many nursing homes in the area, and each one offers something a bit differently. For example, Riverview Place in Moorhead has a woodworking studio, and Eventide is known for its lush outdoor gardens.
Bethany on 42nd, a new branch of the Bethany family, is a state-of-the-art facility and looks like an upscale apartment facility. Amenities are plenty here, and it’s not uncommon to find residents playing Wii in place of card games and knitting.
Walter says nursing homes are ever evolving. “We are seeing people who are sicker and sicker, and people living longer and longer. Some are sick, and some get better and go home. It’s really about adapting to individual needs and requests.”
Walter adds that when someone is leaving the hospital, the decision on which nursing home they will be sent to is often based on where there is an open room. She recommends though, when possible, to tour and get a feel for different places.
“The best thing is to talk to people who might know––the hospital, people who have been there. Gather your facts,” Walter says.
Bursack suggests the nursing home ranking tool at Medicare.gov as a place to start.Memory care
“Memory care staff have been trained in different approaches on dealing with people with memory issues,” Walter says of memory care units, which work with those who have dementia or Alzheimer’s.
Potential residents and their families are educated on what to expect in the memory care community, Walter says. There may be people seen wandering, for example. Walter says they try to make the environment as comfortable and as homelike as possible. Residents participate in activities they can accomplish, and adjustments are made to accommodate each individual resident.
Many memory care facilities offer similar amenities, including Eventide Senior Living and Bethany, both in Fargo.
Memory care units usually have specially trained staff that works with the memory care residents, as well as a secure, outdoor garden designed by memory care experts.
The thoughts offered here are just a beginning. The best way to find the right place for an elder you care about is to educate yourself on the options available, consult with people you trust, and visit so you can see for yourself.
“If something doesn’t feel right or sound right––question it, follow your gut––and take time to talk to current residents––they don’t hold back!” Boeddeker advises. “There are no silly questions when it comes to seeking a new place to live. I approach things this way … would my parents like it? Would they be comfortable here? Always ask questions to be as educated as you can be about senior housing.”